In 2007 I interviewed Dr. Alfred M. Freedman who had been President of the American Psychiatric Association in 1973 when this event occurred. He described the details of how this resolution was passed by the APA Assembly . The interview was part of a video podcast series which I was doing at New York Medical College. It was subsequently transcribed in the Journal of Gay & Lesbian Mental Health Volume 13 Number 1 January -March 2009 pages 62-68. The interview is available on the Internet in 5 short segments. Segments 3-5 deal mostly with this issue. In view of the historical significance of this event. I have put links to this interview below:
Interview with Dr. Freedman – Segment #1 – 6 minutes 20 seconds http://www.youtube.com/watch?v=jhiyDAprlP4
Interview with Dr. Freedman – Segment #2 – 9 minutes 58 seconds http://www.youtube.com/watch?v=smvDA_9GJyE
Interview with Dr. Freedman – Segment #3 – 8 minutes 41 seconds http://www.youtube.com/watch?v=bmtr5kmpBus
Interview with Dr. Freedman – Segment #4 – 7 minutes 59 seconds http://www.youtube.com/watch?v=zLREZflrQrA
Interview with Dr. Freedman – Segment #5 – 4 minutes 24 seconds http://www.youtube.com/watch?v=z5YsWT48lEE
For more information about Dr. Freedman see an earlier blog .
Michael Blumenfield, M.D.
5 Days at Memorial: Life and Death in a Storm Ravaged Hospital by Sheri Fink – This is a great book for anyone who works in a hospital especially doctors and nurses who realize they could be on call when a disaster might strike. Also include yourself in this group if you are a hospital administrator or someone who likes to wrestle with ethical dilemmas. Be prepared for a lot of repetition, medical details that may all seem to be almost the same to most people as well as for some dips into the history of this hospital, other disasters and a course in ethics over the years even dating back to ancient times. If you can handle all of this, you really have an exciting, intellectually stimulating book with a look at disaster medicine, making medical and ethical decisions under difficult circumstances and some good legal battles. The main event was the 2005 Hurricane Katrina, which was the costliest natural disaster, as well as one of the five deadliest hurricanes in the history of the United States. At least 1,833 people died in the hurricane and subsequent floods. This book deals with the impact of the storm on Memorial Hospital in New Orleans, which was a 312-bed hospital, which included patients receiving intensive care and a larger section of the hospital where critically ill patients were treated. As the floodwater rose, most of the power in the hospital was irretrievably lost. There was no sanitation, and they were running out of food. Indoor temperatures were as high as 110 F degrees. At one point there were over 2000 people in the hospital as the numbers swelled with families of patients and staff as well as refugees from the surrounding city. The hospital became surrounded by water and there was no way to leave by car. A makeshift helipad was established on the roof but to get there patients, had to be carried up several flights of stairs usually in the dark and passed through a hole in the wall to get to another part of the hospital complex and up additional stairs. There was limited oxygen for these patients and for some the nurses had to squeeze a balloon like device to get the air into their lungs and drip an IV into their veins while going up the stairs. It was difficult getting enough helicopters to remove all the people from the hospital. Decisions had to be made which patients to evacuate first. Should it be the ones that were barely alive and wouldn’t be expected to even survive the trip to another location or perhaps already had a fatal illness where their demise was expected in a few days or should the patients go first who had a better long term outlook but still required hospital care?? Should the preference or order of care be influenced if the patient had a DNR order, meaning do not resuscitate the patient if their heart stops or if they stop breathing. As the first three or four days passed most of the people were evacuated (where they were evacuated to was another problem). There was confusion and questions about the actions by the corporation that owned the hospital and what arrangements they were making to help the stranded hospital’s need for evacuation. Outside the hospital gunshots were heard and there were concerns that looters might enter the hospital by boat. There was a concern about the physical integrity of the old hospital walls. You would think that the National Guard and the US Government should have done a heroic operation to save everyone from the beginning. They apparently were saving people from rooftops of their homes, helping out in the Superdome, which was the place of last resort for the people of New Orleans who weren’t able to escape before the flood, as well as sporadically appearing on the helicopter pad. In the end there were a small number of doctors and nurses trying to care for the remaining and sickest patients. There was concern that even moving some of them would be fatal. One man was so obese that they couldn’t figure out how to move him. Some patients were clearly in the last hours hours of their lives. Others would soon be that way if they didn’t get more intensive care. One of the remaining doctors along with two nurses was Dr. Anna Pous, a very compassionate and brilliant ENT surgeon who had a history of reconstructing patients with advanced cancer. She found herself faced with the task of trying to relieve the suffering of several remaining patients. It is well known to physicians and nurses who treat dying patients, that morphine often in combination with a rapid acting tranquillizer such as Versed, given intravenously will relieve the pain and agonizing difficulty breathing in the final stages of life. It is also known that this treatment could hasten their demise. Dr. Pous appeared to made the decision to have several patients receive large doses of morphine and Versed which would peacefully end their lives. At a later point in time this was felt by some people to be murder. In fact, Dr. Pous was actually arrested, handcuffed and was with two nurses charged with second-degree murder. The response of the medical community from this hospital and from across the country, the legal and emotional reactions of some of the patient’s families, the media hype and the ethical questions which were being asked, were an important part of this book. The book provides few answers and lots of stimulating questions. The author won a Pulitzer Prize for her reporting on this subject in the New York Times Magazine. If you are drawn to this subject you will not be disappointed.
Although I am not an expert in this area, I believe that this will be a landmark book for families, educators and any professionals who work with young people with autism. It is a book of short essays written by a 15 year old about his experience with his condition starting with some pieces written when he was 12 years old.
What is unusual, unique and very important about this author is that he cannot speak and only when he was about 11 years old did he begin to communicate by pointing to letters on a letter board. Up to that point no one had any idea that he was an above average intelligent kid who began to read when he was about three years old. He was terribly frustrated by being treated by well meaning experts in autism and education by drilling him on simple exercises meant for a three year old child who was having trouble learning. He was asked to point to his nose which he often could not do and was judged accordingly. Even when he began to point to letters and make intelligent sentences, just about everyone thought that his mother was guiding his hand since she had to steady it for him to point. It took his father, who is a scientist, two more years before he was convinced that his son was truly communicating fully formed intelligent sentences. The problem would seem to be that he could not control his body. He often would have great difficulty even signaling that he could make even simple calculations or understood basic concepts. This was further complicated by his arm flapping which would occur when he was anxious which he referred to as “stims” . Other times he would do unexplainable pieces of behavior such as pulling his Mom’s hair or that of beloved aide when he was frustrated or embarrassed. This pattern of behavior is common in many children who fall under the rubric of autism except they are usually not recognized to understand things and mainly have trouble in controlling their bodies to communicate. Instead they are often deemed “retarded” and/or “developmentally handicapped.”
Ido believes that he is not “one in a million” and that he has had indication that many of his friends with non verbal autism are as frustrated as he used to be. Once Ido proved he could communicate with a letter board and then on the keys of a computer, a new world opened up to him. He was put in mainstream classes which he would attend with an aide and has entered high school with the aspiration to go to college. It is a constant uphill battle, as while the administrators of his middle school were very supportive, he found that was not the case of the first high school which he entered. Obviously, it did takes a great deal of resources and some special accommodation to allow him to function in a regular high school environment. After transferring to a second high school he seemed to be quite adjusted as he continues forth.
This book traces his progress as well as clarifying many of his characteristics and experiences. For example he sees people in different colors such as red blue, yellow etc. which are related to their emotional state perhaps in relationship to himself. He is also very sensitive to sound and appears to have very keen hearing . He therefore at times gets overwhelmed by loud noises, certain music. being in the presence of multiple people talking . These and other situations can cause him to have what would appear to be overwhelming panic attacks. This is not only experienced as severe anxiety but it intensifies uncontrolled movements of his body. Over the years he has found that various types of physical training and exercise actually improved his self control, something that was not initially recognized as it was neglected in any attempts to assist him.
I found it interesting, as a psychiatrist, that he did not mention whether or not he was given a trial on any anti-anxiety and anti-panic medications which are believed to directly effect various pathways in the brain which are involved when people have such overwhelming emotions. I would imagine that the medical experts in this field have evaluated the effect of such drugs as an adjunct to his treatment program but if they have not, it certainly should be done.
Ido frequently mentions that he knows that he has an illness that places many limitations on him but he prefers to focus on what he can do and what he hopes to be able to do in the future. He also is dedicated to teaching the public as well as families of children with autism and experts about the potential of people like himself. Ido would probably say “so called experts” since he has a sense of humor and he is keenly aware of how so many experts have misinterpreted his abilities). Not only is he becoming an advocate but he must be also considered to be a hero for so many people who are locked in the land of autism.
For a view of brief video clip of Ido at a meeting as one of his speeches is read go to: http://www.youtube.com/watch?v=V4VR1KYRX8s
(This book can be purchased through AMAZON by clicking the AMAZON link in the right hand column)
My friend and colleague Abe Halpern passed away on April 20, 2013. Abe was a remarkable and unforgettable person. He was a loving and dedicated husband, father, grandfather and and great grandfather. He also was a skilled forensic psychiatrist and an activist for many the causes in which he deeply cared about.
Abe and I belonged to the same District Branch (Westchester Psychiatric Society) of the American Psychiatric Association and were both on the faculty of New York Medical College in Valhalla, New York, so I had numerous opportunities to see him in action. I also observed him stand up for his beliefs at the Assembly of the American Psychiatric Association where he introduced various resolutions which were passed due to his persuasive advocacy. He was a reader of this blog and was kind enough to frequently make constructive suggestions to me.
I had the opportunity to sit and down and conduct a one to one recorded interview with Abe where he discussed three topics which were dear to his heart. This interview is presented below in three parts:
Born 2/2/1925. Died 4/20/2013 as a result of an earlier fall. His family emigrated to Canada in 1927. As a teenager, he joined the Royal Canadian Navy serving in both the Atlantic and Pacific theaters during WWII. After the Korean War, he was honorably discharged at the rank of Lieutenant Surgeon Commander. A medical school graduate of the University of Toronto, he practiced psychiatry for over 50 years and was a leader in the subspecialty of forensic psychiatry. Awards from the American Medical Association, American Psychiatric Association, and from many other organizations of medicine reflect a life dedicated to human rights. He marched with Martin Luther King, Jr. in Selma, fought against China’s torture of the Falun Gong and illegal organ transplantation, the misuse of the insanity defense, and forced psychiatric hospitalization without judicial review. He was a national and international leader against the involvement of physicians in capital punishment and also physician participation in coerced interrogations of prisoners. All were subject of his prolific publications. He is survived by his beloved wife Marilyn, and his loved children (and spouses) Howard, Lon (Barbara), Marnen (Herdis), Chaia (Adam), Mark (Tomoko), Emily, and John. He was an adoring grandfather of 11 and great-grandfather of 5.
On May 20th 2013 the Social Psychiatry Committee of the APA awarded Abe Halpern the Humanitarian Award. John Halpern accepted the award on behalf of his father. In the future this award will be named the Abe Halpern Humanitarian Award. Click here to see John’s tribute to his dad on that day
Suicide is the 11th leading cause of all death in the United States. It is one of most important issues which mental health professionals are concerned about in their clinical work. The American Academy of Psychoanalysis and Dynamic Psychiatry of which I have the honor of currently being President, has designated the title of its 57th annual meeting as: Psychodynamics: Essential to the Issue of Suicide and Other Challenges to Modern Day Psychodynamic Psychiatry. It is fitting that the meeting is being held in San Francisco which although not on the top 15 cities with the highest suicide rate does have the Golden Gate Bridge as its symbol which is the second most common suicide site in the world.(see previous posts on this subject) Any mental health professional is cordially invited to register and attend this meeting (see AAPDP.org) which will take place May 16-18 2013.
Mental health professional must always consider the suicidal potential of any patient especially when that patient is depressed or experiences significant distress. I recall as a junior psychiatry resident when I first was given the responsibility of making a decision to hospitalize patients (even against their will) because I felt he or she was a danger to themselves (or others). As much as this is a heavy burden, it is likewise a major responsibility not to hospitalize a suicidal patientand face a situation where this person has ended their own life. In the latter case there also is the possibility of legal consequences.
If a person is determined to end his or her own life, they will ultimately succeed. However when the desire to do it is due to a mental condition that we can treat, there is a good chance that we can prevent the suicide if we can intervene and facilitate proper treatment. Unfortunately this is not always the case since patients who are in treatment or who have had treatment do kill themselves.
Depression is the most common condition which has the potential to lead to suicide. This may be part of biological condition with genetic components which brings about severe bouts of depression. Depression may be part of the grieving process or it may be due to complicated psychological reasons which lead some people to be so depressed that they want to end their life.
Sometimes there is anger at a lost object (person) that gets turned inward leading to self destructive acts. When the ability to test reality is lost, the reasoning for suicidal actions can be quite bizarre and may include internal voices commanding the persons to hurt or kill themselves. There are still other situations where a person does a self destructive act, not with intent to commit suicide but rather with an intent to suffer or manipulate others but inadvertently does die as a result of this gesture. There are certain personality patterns where there may be repeated suicidal gestures which have the potential to be fatal or very harmful. Drugs and alcohol and complicate the problems and may actually be the cause of suicide.
There are some special circumstances where a patient with a serious, very painful or perhaps fatal illness may want to end his or her life or may ask the doctor to facilitate their demise. There are ethical discussions how should this be handled. In some of these situations, if pain and discomfort is better controlled this may not be an issue.
The treatment for a patient with suicidal potential is a delicate situation. First the decision needs to be made if the treatment is to be inpatient or outpatient (sometimes a combination of both). There needs to be a treatment plan that will almost always require psychotherapy frequently with a combination of psychopharmacology. In rare situations ECT (Electric Convulsive Treatment) will be utilized. Family and close friends often play an important role in the support of the person with suicidal thoughts. While psychotherapy needs to be confidential, the patient needs to understand that under certain circumstances where the therapist believes that the patient is an immediate danger to self or others, the therapist may have to break the confidentiality for the benefit of the patient. It goes without saying that there needs to be a trusting relationship with the therapist so the patient understands that there are two people working together in the best interest of the patient.
Many of these topics and others are going to be addressed at the San Francisco meeting of the American Academy of Psychoanalysis and Dynamic Psychiatry May 16-18 at the Westin St Francis Hotel which was mentioned at the beginning of this blog. All mental health professionals are welcome to register either in advance or onsite and attend the meeting . Go to AAPDP.org for more information or you can contact me if there are any questions. There will three plenary sessions by Drs Mardi Horowitz, Jeste Dillip and Herbert Pardes as well as many panels and workshops. There will also be a very interesting documentary about suicide titled, Don’t Change The Subject with a discussion with Mike Stutz, the filmmaker after it is shown. A few of these presentations will be made available to Auto-Digest subscribers but if you are able to attend in person, I suggest that you do so. I look forward to meeting any attendees at the meeting.